延迟筋膜闭合替代腹疝修补：开放性腹部处理的下一步措施

Late fascial closure in lieu of ventral hernia: the next step in open abdomen management.

作者信息

Miller Preston R, Thompson James T, Faler Byron J, Meredith J Wayne, Chang Michael C

机构信息

Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27514, USA.

出版信息

J Trauma. 2002 Nov;53(5):843-9. doi: 10.1097/00005373-200211000-00007.

DOI:10.1097/00005373-200211000-00007

PMID:12435933

Abstract

BACKGROUND

The use of open abdomen techniques in damage control laparotomy and abdominal compartment syndrome has led to development of several methods of temporary abdominal closure. All of these methods require creation of a planned hernia with later reconstruction in patients unable to undergo fascial closure in the early postoperative period. We review a method of late primary fascial closure, thus eliminating the need for delayed reconstruction in some patients.

METHODS

The records of all patients managed with open abdomens over a 5-year period at a Level I trauma center were reviewed for injury characteristics, operative treatment, final abdominal closure type and timing, and outcome. Patients requiring open abdomen who were unable to undergo fascial closure in the early postoperative period were managed with a vacuum-assisted fascial closure (VAFC) technique. This allows for constant tension on the wound edges and facilitates late fascial closure. Patients managed with planned hernia (HERNIA group) were compared with those undergoing fascial closure > or = 9 days after initial laparotomy (LATE group) for injury severity, fistula rate, and mortality. All patients in the LATE group underwent VAFC.

RESULTS

From September 1996 to October 2001, 148 patients required management with an open abdomen. Fifty-nine underwent fascial closure, 37 of these before postoperative day 9 and 22 on or after day 9. Mean time to closure in the LATE group was 21 days (range, 9-49 days). Injury Severity Scores were similar in the HERNIA and LATE groups (26 vs. 30, p = 0.28), as were admission base deficit (-8.8 vs. -9.5, p = 0.71), number of fistulas (1 vs. 0, p = 0.99), and mortality (17% vs. 14%, p = 0.99).

CONCLUSION

VAFC enables late fascial closure in open abdomen patients up to a month after initial laparotomy. Complication rates do not differ from patients with planned hernia, and the need for future abdominal wall reconstruction is avoided.

摘要

背景

在损伤控制剖腹术和腹腔间隔室综合征中使用开放腹腔技术已促使多种临时腹腔关闭方法的发展。所有这些方法都需要在术后早期无法进行筋膜关闭的患者中制造计划性疝，随后进行重建。我们回顾一种晚期一期筋膜关闭方法，从而消除部分患者延迟重建的必要性。

方法

回顾了一家一级创伤中心5年间所有接受开放腹腔治疗患者的记录，内容包括损伤特征、手术治疗、最终腹腔关闭类型和时间以及结果。术后早期无法进行筋膜关闭的开放腹腔患者采用真空辅助筋膜关闭（VAFC）技术进行治疗。这可使伤口边缘保持持续张力并便于晚期筋膜关闭。将采用计划性疝治疗的患者（疝组）与初次剖腹术后9天或更晚进行筋膜关闭的患者（晚期组）在损伤严重程度、瘘发生率和死亡率方面进行比较。晚期组的所有患者均接受了VAFC。

结果

从1996年9月至2001年10月，148例患者需要进行开放腹腔治疗。59例患者进行了筋膜关闭，其中37例在术后第9天之前，22例在第9天或之后。晚期组的平均关闭时间为21天（范围9 - 49天）。疝组和晚期组的损伤严重程度评分相似（分别为26和30，p = 0.28），入院碱缺失（分别为 - 8.8和 - 9.5，p = 0.71）、瘘的数量（分别为1和0，p = 0.99）以及死亡率（分别为17%和14%，p = 0.99）也相似。